| NPI | 1972744381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301098001) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 225367) |
| Enumeration Date | 2009-03-13 |
| Last Update Date | 2022-04-12 |